Awake brain surgery,
also called awake craniotomy, is a type of procedure performed on the brain
while the person is awake and alert. Most of the brain surgeries involve
general anesthesia wherein the patient is completely sedated and paralyzed and
his/her breathing is controlled by the ventilator.
Awake brain surgery
involves keeping the person awake and alert during surgery so as to be able to
monitor his/her brain function while a surgical procedure is being performed on
the brain.
Awake brain surgery
is used to treat some brain tumors that are in close proximity to important
functional areas of the brain such as the speech area and motor area. Patient’s
responses help the surgeon to ensure that the functional area under
consideration is preserved, thus preserving function. The procedure also lowers
the risk of damage to functional areas of your brain that could affect your
vision, movement or speech.
Why it's done?
If a tumor or section
of your brain that causes seizures needs surgical removal, doctors must be sure
that they are not damaging an area of the brain that affects your language,
speech and motor skills.
It's difficult to pinpoint
those areas exactly before surgery. Awake brain surgery allows the surgeon to know
exactly which areas of the brain control those functions and avoid them.
Before surgery
Not all
patients are fit candidates for awake craniotomy. The treating neurosurgeon and
neuroanesthesiologist examine the patient thoroughly and discuss the steps in
surgery. The patient is an active participant in this surgery and his/her
responses during surgery will play a pivotal role in preserving brain function.
A neuropsychological assessment is performed to assess deficits in higher
mental functions and speech prior to the surgery.
Before
surgery, the neurosurgeon or a speech-language pathologist may ask the patient
to identify pictures and words on cards or on a computer so that the answers
can be compared during surgery.
During surgery
Brain
mapping
An anesthesia
specialist (anesthesiologist) will apply numbing medications to the scalp to
ensure your comfort.
During the
procedure, doctors place the patient’s head in a fixed position to keep the
head still and ensure surgical accuracy. Some of the hair will be clipped. Your
surgeon then removes part of the skull to reach the brain.
The patient
may be sedated and sleepy while part of the skull is removed in the beginning
of the surgery, and also when doctors reattach the skull at the end of the
surgery. During the surgery, the anesthesiologist will stop administering the
sedative medications and allow the patient to wake up.
If the brain tumor
or epileptic focus is close to areas of your brain that control vision, speech
or movement, the neurosurgeon will conduct brain mapping. This provides the
neurosurgeon with a map of the brain centers that control each of these
functions. The surgeon also can perform brain mapping deeper in your brain
during surgery.
The
anesthesiologist and surgical team carefully monitors and assess your body and
brain functions and alerts your surgeon if surgery affects brain function.
After surgery
The patient is
observed in the intensive care unit for a while after surgery and spends about three
to five days in the hospital.
The patient
generally may return to work and normal activities in six weeks to three
months.
